All 82 Universities: Names and Amounts Revealed for Pharmaceutical Payments to Hospital Directors and Medical School Deans

The top 10 recipients, including Hironori Sagara, Director of Showa Medical University Hospital, received more than ¥100 million in total, highlighting the concentration of pharmaceutical payments among senior medical leaders.

Akihiko Ozaki, M.D., Ph.D.

Physician at the Medical Governance Research Institute

Chiba University Hospital, where Koutaro Yokote, a high-value recipient, previously served (from the hospital introduction video)

This magazine has previously covered, on three occasions, a series of criminal cases centered on the University of Tokyo School of Medicine and has highlighted the large honoraria received by senior figures from pharmaceutical and medical device companies as a possible contributing factor. The failure of organizational autonomy—the ability of institutions to govern themselves effectively—may have contributed to these scandals. However, this problem is a common structural issue for all Japanese university medical schools. This paper expands its perspective to university hospitals nationwide and examines the financial relationship between leadership and pharmaceutical companies.

Showa Medical University Hospital Director Received the Highest Amount

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First, let us look at university hospital directors. A professor at a university medical school is equivalent to a director-level position in a general company. The hospital director who supervises the professors is the chief executive of the university hospital.

According to the Yen for Docs Database, pharmaceutical companies paid approximately ¥260.98 million in honoraria in FY2023 to 84 hospital directors at the main hospitals of all 82 university medical schools, including two former hospital directors. The average amount received was about 3.11 million yen, and the median was about 1.99 million yen. Payments were highly concentrated: the top 10 recipients alone accounted for approximately ¥102.51 million, or about 39% of the total.

The largest amount received was Mr. Hironori Sagara (Department of Respiratory and Allergy Medicine), director of Showa Medical University Hospital, with about 15.48 million yen. Dr. Sagara graduated from Dokkyo Medical University School of Medicine in 1987. In 2013, he became chief professor of the Department of Respiratory and Allergy Medicine at Showa University School of Medicine, and he has held his current position since April 2020.

Dr. Sagara received ¥4.77 million in 36 payments from GlaxoSmithKline K.K. and ¥4.25 million in 33 payments from AstraZeneca plc. Both companies are major manufacturers of asthma drugs, and GlaxoSmithKline K.K. develops inhaled drugs "Adoair" and "Relvar" and anti-IL-5 antibody "Nucala". On the other hand, AstraZeneca plc also sells biologics such as the severe asthma drugs "Fasenra" and "Tezspire" in addition to "Symbicort". One of Dr. Sagara's specialties is bronchial asthma, and his frequent appearances at lectures sponsored by the two companies may have contributed to the accumulation of these honoraria.

What is even more problematic is that Mr. Sagara has been the chairman of the Association of Japan Medical Colleges since 2024. The Association discusses educational, research, and clinical issues common to medical training institutions and aims to contribute to the improvement of medicine and medical care in Japan. The fact that an organization with such a strong public-interest role is headed by someone with extensive financial ties to pharmaceutical companies highlights a structural problem in Japan's medical community.

Next, we examine pharmaceutical payments to the de facto heads of medical schools, including deans of medical schools and graduate schools of medicine. A university hospital is an affiliated institution of the medical school, and the dean of the medical school is organizationally above the hospital director. However, the role is usually more focused on student education and research management than on clinical practice. The total amount of honorarium paid by pharmaceutical companies to the de facto heads of 82 university medical schools in FY23 was about 127.56 million yen. The average amount received was approximately ¥1.56 million, and the median was approximately ¥690,000. Payments were again concentrated among a small number of university executives, with the top 10 recipients accounting for approximately ¥60.42 million, or about 47% of the total.

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The largest recipient was Dr. Akira Nishiyama, Dean of the Kagawa University School of Medicine, who received approximately ¥9.93 million. As a professor of pharmacology, a basic science field, he is somewhat unusual among physicians receiving large pharmaceutical-company payments. Mr. Nishiyama graduated from Kagawa Medical University (now Kagawa University) and assumed his current position after serving as a professor in the Department of Pharmacology.

In renal and cardiovascular pharmacology, Dr. Nishiyama's specialty, the pharmaceutical market includes many major drug classes, such as antihypertensive agents and heart-failure treatments, and pharmaceutical companies have traditionally sponsored numerous research meetings and lectures in this field. Despite his busy schedule, Dr. Nishiyama frequently updates the "Together with a Reborn Kagawa University School of Medicine: Dean's Blog," which offers a glimpse of his personality.

Lecture honoraria tend to go to clinicians, so the fact that a basic researcher receives such large payments may reflect the value placed on these qualities.

Even so, one has to ask whether there is a guiding conviction about what it means to be a physician. Close ties between pharmaceutical companies and healthcare professionals in the cardiovascular field have long been criticized, and this is a pattern the medical community should move away from. In keeping with the phrase "a reborn Kagawa University School of Medicine," I hope he will show society and students a new model of how physicians should relate to pharmaceutical companies.

President Yokote of Chiba University stands out

Finally, let us examine pharmaceutical payments received by university presidents. It is not uncommon for medical school graduates to become university presidents, but the role, of course, involves overseeing the entire university. For an academic, the university presidency can be regarded as a capstone position, but amid Japan's declining birthrate, it also carries major responsibility for the university's survival, including attracting international students and pursuing institutional reorganization.

In particular, unlike private universities, where the intentions of the board of directors are strongly reflected, in national and public universities, the president has great authority and responsibility as the head of the organization. In this sense, the president's actions show the attitude of the university itself.

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Of the 86 national university presidents, 29 were medical school graduates, and payments from pharmaceutical companies in FY2023 were confirmed for 16 of them.　The largest recipient was Koutaro Yokote, President of Chiba University and a specialist in diabetes, metabolism, and endocrinology, who received approximately ¥10.77 million, far more than any other university president.

Dr. Yokote is a graduate and researcher of Chiba University School of Medicine and is known for his work on lifestyle-related diseases such as diabetes and metabolic syndrome. He served as a professor at the university's School of Medicine and as director of Chiba University Hospital before assuming his current post.

Yokote has long appeared on lists of high-value recipients of pharmaceutical payments. An analysis published by this magazine in May 2022 reported that he received a total of ¥82.58 million over the four years from 2016 to 2019. Yokote became university president in 2024. Even before then, from 2020 onward, he held highly public-facing positions within the university, including hospital director and vice president. From 2022 onward, he also served as representative of the Association of Japan Medical Colleges, as Dr. Sagara's predecessor.

Now, this behavior by the leadership and the structural problems that have allowed it cannot be overlooked as the management of university hospitals becomes more severe. According to the Association of Japan Medical Colleges, university hospitals recorded a combined ordinary deficit of ¥50.8 billion in FY2024. In response, the Ministry of Education, Culture, Sports, Science and Technology allocated ¥34.9 billion in a supplementary budget for FY2025 to strengthen university hospital functions. With consumer prices rising 3.1% in 2025 and people across Japan feeling the burden of inflation, university hospitals are receiving support funded by taxpayers.

Naturally, the leaders of university hospitals, medical schools, and university administrations are expected to demonstrate corresponding accountability and autonomy. They are in a position where reforms—including reconsidering their own compensation—should be on the table. This is hardly a time for them to be receiving lecture honoraria from pharmaceutical companies outside their primary duties. If the president of a company listed on the Tokyo Stock Exchange Prime Market neglected his primary duties while earning income from outside lectures and then appealed for public funding because the company was in the red, he would inevitably face public ridicule and criticism. Unfortunately, this is the reality of many university hospitals.

Above all, what stands out is a lack of ownership and urgency regarding university hospital management. The healthcare delivery system—including the mix of clinical departments and number of positions—is often discussed simply as an extension of existing arrangements, while concrete discussion of which departments are running deficits and how to improve them remains insufficient. As the population declines, particularly in rural areas, it is unrealistic to maintain the current number of university hospitals and clinical departments indefinitely. University hospitals, too, must be prepared to rethink their healthcare delivery systems from the ground up.

No Different from Young Doctors Who Go Straight into Cosmetic Medicine

Another point that should not be overlooked is that medical students and young physicians are watching how senior leaders behave.

Currently, the medical community in Japan has raised concerns about the growing number of physicians who enter cosmetic medicine immediately after completing their initial postgraduate training—a career path colloquially known as chokubi (直美). A 2022 survey counted approximately 198 such physicians, a 12-fold increase over the previous decade, raising concerns about shortages in regional healthcare.

However, this can also be seen as the result of young physicians optimizing their own career choices. From a broader perspective, it is not fundamentally different from senior leaders seeking to maximize their own income while hospitals face severe financial pressures. Neither behavior can readily be said to meet society's trust and expectations, and both risk undermining confidence in the medical profession.

If so, it is difficult to justify criticism directed only at young physicians. Young doctors learn professional norms within organizations, and the behavior of senior leaders can strongly shape their values.

Professional ethics are not learned from lectures. What organizational leaders value and how they act—those examples help shape the values of the next generation of physicians.

Author Profile

Akihiko Ozaki

Physician at the Medical Governance Research Institute

Graduated from the University of Tokyo School of Medicine in 2010. Deeply affected by the Great East Japan Earthquake during his residency, he moved to Fukushima Prefecture. Alongside his work in general surgery, he addresses health issues related to the disaster. His specialty is breast cancer.

This article was originally published in FACTA on September 21, 2026.